Gastroparesis, also called delayed gastric emptying, is a
disorder in which the stomach takes too long to empty its contents.
It often occurs in people with type 1 diabetes or type 2
diabetes.

Gastroparesis happens when nerves to the stomach are damaged or
stop working. The vagus nerve controls the movement of food through
the digestive tract. If the vagus nerve is damaged, the muscles of
the stomach and intestines do not work normally, and the movement of
food is slowed or stopped.

Diabetes can damage the vagus nerve if blood glucose levels
remain high over a long period of time. High blood glucose causes
chemical changes in nerves and damages the blood vessels that carry
oxygen and nutrients to the nerves.

If food lingers too long in the stomach, it can cause problems
like bacterial overgrowth from the fermentation of food. Also, the
food can harden into solid masses called bezoars that may cause
nausea, vomiting, and obstruction in the stomach. Bezoars can be
dangerous if they block the passage of food into the small
intestine.

Gastroparesis can make diabetes worse by adding to the difficulty
of controlling blood glucose. When food that has been delayed in the
stomach finally enters the small intestine and is absorbed, blood
glucose levels rise. Since gastroparesis makes stomach emptying
unpredictable, a person's blood glucose levels can be erratic and
difficult to control.

The diagnosis of gastroparesis is confirmed through one or more
of the following tests.

Barium x ray. After fasting for 12 hours, you will
drink a thick liquid called barium, which coats the inside of the
stomach, making it show up on the x ray. Normally, the stomach
will be empty of all food after 12 hours of fasting. If the x ray
shows food in the stomach, gastroparesis is likely. If the x ray
shows an empty stomach but the doctor still suspects that you have
delayed emptying, you may need to repeat the test another day. On
any one day, a person with gastroparesis may digest a meal
normally, giving a falsely normal test result. If you have
diabetes, your doctor may have special instructions about
fasting.

Barium beefsteak meal. You will eat a meal that
contains barium, thus allowing the radiologist to watch your
stomach as it digests the meal. The amount of time it takes for
the barium meal to be digested and leave the stomach gives the
doctor an idea of how well the stomach is working. This test can
help detect emptying problems that do not show up on the liquid
barium x ray. In fact, people who have diabetes-related
gastroparesis often digest fluid normally, so the barium beefsteak
meal can be more useful.

Radioisotope gastric-emptying scan. You will eat food
that contains a radioisotope, a slightly radioactive substance
that will show up on the scan. The dose of radiation from the
radioisotope is small and not dangerous. After eating, you will
lie under a machine that detects the radioisotope and shows an
image of the food in the stomach and how quickly it leaves the
stomach. Gastroparesis is diagnosed if more than half of the food
remains in the stomach after 2 hours.

Gastric manometry. This test measures electrical and
muscular activity in the stomach. The doctor passes a thin tube
down the throat into the stomach. The tube contains a wire that
takes measurements of the stomach's electrical and muscular
activity as it digests liquids and solid food. The measurements
show how the stomach is working and whether there is any delay in
digestion.

Blood tests. The doctor may also order laboratory tests
to check blood counts and to measure chemical and electrolyte
levels.

To rule out causes of gastroparesis other than diabetes, the
doctor may do an upper endoscopy or an ultrasound.

Upper endoscopy. After giving you a sedative, the
doctor passes a long, thin tube called an endoscope through the
mouth and gently guides it down the esophagus into the stomach.
Through the endoscope, the doctor can look at the lining of the
stomach to check for any abnormalities.

Ultrasound. To rule out gallbladder disease or
pancreatitis as a source of the problem, you may have an
ultrasound test, which uses harmless sound waves to outline and
define the shape of the gallbladder and
pancreas.

The primary treatment goal for gastroparesis related to diabetes
is to regain control of blood glucose levels. Treatments include
insulin, oral medications, changes in what and when you eat, and, in
severe cases, feeding tubes and intravenous feeding.

It is important to note that in most cases treatment does not
cure gastroparesis--it is usually a chronic condition. Treatment
helps you manage the condition so that you can be as healthy and
comfortable as possible.

Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more
slowly and at unpredictable times. To control blood glucose, you may
need to

Your doctor will give you specific instructions based on your
particular needs.

Medication

Several drugs are used to treat gastroparesis. Your doctor may
try different drugs or combinations of drugs to find the most
effective treatment.

Metoclopramide (Reglan). This drug stimulates stomach
muscle contractions to help empty food. It also helps reduce
nausea and vomiting. Metoclopramide is taken 20 to 30 minutes
before meals and at bedtime. Side effects of this drug are
fatigue, sleepiness, and sometimes depression, anxiety, and
problems with physical movement.

Erythromycin. This antibiotic also improves stomach
emptying. It works by increasing the contractions that move food
through the stomach. Side effects are nausea, vomiting, and
abdominal cramps.

Domperidone. The Food and Drug Administration is
reviewing domperidone, which has been used elsewhere in the world
to treat gastroparesis. It is a promotility agent like
metoclopramide. Domperidone also helps with nausea.

Other medications. Other medications may be used to
treat symptoms and problems related to gastroparesis. For example,
an antiemetic can help with nausea and vomiting. Antibiotics will
clear up a bacterial infection. If you have a bezoar, the doctor
may use an endoscope to inject medication that will dissolve
it.

Meal and Food Changes

Changing your eating habits can help control gastroparesis. Your
doctor or dietitian will give you specific instructions, but you may
be asked to eat six small meals a day instead of three large ones.
If less food enters the stomach each time you eat, it may not become
overly full. Or the doctor or dietitian may suggest that you try
several liquid meals a day until your blood glucose levels are
stable and the gastroparesis is corrected. Liquid meals provide all
the nutrients found in solid foods, but can pass through the stomach
more easily and quickly.

The doctor may also recommend that you avoid high-fat and
high-fiber foods. Fat naturally slows digestion--a problem you do
not need if you have gastroparesis--and fiber is difficult to
digest. Some high-fiber foods like oranges and broccoli contain
material that cannot be digested. Avoid these foods because the
indigestible part will remain in the stomach too long and possibly
form bezoars.

Feeding Tube

If other approaches do not work, you may need surgery to insert a
feeding tube. The tube, called a jejunostomy tube, is inserted
through the skin on your abdomen into the small intestine. The
feeding tube allows you to put nutrients directly into the small
intestine, bypassing the stomach altogether. You will receive
special liquid food to use with the tube. A jejunostomy is
particularly useful when gastroparesis prevents the nutrients and
medication necessary to regulate blood glucose levels from reaching
the bloodstream. By avoiding the source of the problem--the
stomach--and putting nutrients and medication directly into the
small intestine, you ensure that these products are digested and
delivered to your bloodstream quickly. A jejunostomy tube can be
temporary and is used only if necessary when gastroparesis is
severe.

Parenteral Nutrition

Parenteral nutrition refers to delivering nutrients directly into
the bloodstream, bypassing the digestive system. The doctor places a
thin tube called a catheter in a chest vein, leaving an opening to
it outside the skin. For feeding, you attach a bag containing liquid
nutrients or medication to the catheter. The fluid enters your
bloodstream through the vein. Your doctor will tell you what type of
liquid nutrition to use.

This approach is an alternative to the jejunostomy tube and is
usually a temporary method to get you through a difficult spell of
gastroparesis. Parenteral nutrition is used only when gastroparesis
is severe and is not helped by other methods.

New Treatments

A gastric neurostimulator has been developed to assist people
with gastroparesis. The battery-operated device is surgically
implanted and emits mild electrical pulses that help control nausea
and vomiting associated with gastroparesis. This option is available
to people whose nausea and vomiting do not improve with
medications.

The use of botulinum toxin has been shown to improve stomach
emptying and the symptoms of gastroparesis by decreasing the
prolonged contractions of the muscle between the stomach and the
small intestine (pyloric sphincter). The toxin is injected into the
pyloric sphincter.

NIDDK's Division of Digestive Diseases and Nutrition supports
basic and clinical research into gastrointestinal motility
disorders, including gastroparesis. Among other areas, researchers
are studying whether experimental medications can relieve or reduce
symptoms of gastroparesis, such as bloating, abdominal pain, nausea,
and vomiting, or shorten the time needed by the stomach to empty its
contents following a standard meal.

Gastroparesis may occur in people with type 1 diabetes or type
2 diabetes.

Gastroparesis is the result of damage to the vagus nerve,
which controls the movement of food through the digestive system.
Instead of the food moving through the digestive tract normally,
it is retained in the stomach.

Symptoms of gastroparesis include early fullness, nausea,
vomiting, and weight loss.

Gastroparesis is diagnosed through tests such as x rays,
manometry, and scanning.

Treatments include changes in when and what you eat, changes
in insulin type and timing of injections, oral medications, a
jejunostomy, parenteral nutrition, gastric neurostimulators, or
botulinum toxin.

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